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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 114-116

Double dens evaginatus on permanent maxillary first molar: A case report of this rare occurrence


1 Department of Oral and Maxillofacial Pathology, H. P. Government Dental College, Shimla, Himachal Pradesh, India
2 Department of Pediatric and Preventive Dentistry, H. P. Government Dental College, Shimla, Himachal Pradesh, India

Date of Web Publication26-May-2017

Correspondence Address:
Seema Thakur
Department of Pediatric and Preventive Dentistry, H. P. Government Dental College, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_84_16

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  Abstract 

Dens evaginatus (DE) is a developmental aberration of a tooth resulting in the formation of an accessory cusp. This uncommon anomaly projects above the adjacent tooth surface, exhibiting enamel covering a dentinal core that usually contains pulp tissue. DE usually occurs in mandibular premolars. The most comprehensive grouping of DE on premolars has been done by Schulze (1987). DE may pose various dental problems to clinicians. This case report describes a very rare case of double DE on the permanent maxillary first molar of 14-year-old boy. Till date, there is no such documented case. The deep caries of this tooth was restored.

Keywords: Dens evaginatus, maxillary first molar, supernumerary cusp


How to cite this article:
Thakur NS, Thakur S. Double dens evaginatus on permanent maxillary first molar: A case report of this rare occurrence. Indian J Dent Sci 2017;9:114-6

How to cite this URL:
Thakur NS, Thakur S. Double dens evaginatus on permanent maxillary first molar: A case report of this rare occurrence. Indian J Dent Sci [serial online] 2017 [cited 2021 Mar 7];9:114-6. Available from: http://www.ijds.in/text.asp?2017/9/2/114/207110


  Introduction Top


Supernumerary cusps are common variations of tooth morphology that are occasionally seen clinically. However, their incidences differ depending on the type and the tooth affected. Three of the most commonly reported variations of accessory cusps are Carrabelli cusps of the molars, Talon cusps of the incisors, and Dens evaginatus (DE) of the premolar. These variations are both seen in primary and permanent dentitions. Variations in size, shape, location, and composition of these anomalies have been reported in the literature.[1]

DE is a developmental aberration of a tooth resulting in the formation of an accessory cusp, exhibiting enamel covering a dentinal core that usually contains pulp tissue that on occasion may have a slender pulp horn which extends various distances up to the full length of the tubercle's dentin core.[2]

DE occurs predominantly among the people of Asian descent with varying estimates reported at 0.5%–4.3%, depending on the population group studied.[3]

DE can arise on any tooth but is most commonly associated with premolars.[4]

Schulge (1987) distinguishes the following five types of DE for posterior teeth by the location of the tubercle.[3]

  1. A cone-like enlargement of the lingual cusp. This is a gradually growing serial characteristic, with the following phases:
    1. A cone-shaped lingual cusp more distinct in the buccal direction
    2. A significantly enlarged lingual cusp with distinct marginal wrinkles
    3. A separately developed central cusp on the lingual crown side. The marginal wrinkles merge into a cingulum.
  2. A supernumerary cusp, which is similar to the previous (c) shape. The original lingual cusp is clearly seen next to the central cusp
  3. It is an extra cusp, a form of a tuberculum arising from the occlusal surface
  4. An extra occlusal cusp is situated on the lingual surface of the buccal cusp
  5. Bulging of the lingual ridge of the buccal cusps of premolars and mesiobuccal cusp of molars.


The purpose of this report is to highlight an incidental clinical finding of double DE on maxillary permanent first molar as a very rare dental anomaly.


  Case Report Top


A 14-year-old boy reported to the Department of Paediatric and Preventive Dentistry for the treatment of decayed upper right posterior tooth. Family and health histories were noncontributory. On intraoral examination, no abnormalities of soft tissues were found. All the permanent teeth were erupted except the third molars. Detailed dental evaluation was carried out, and it was found that 16 had a large mesial caries. In addition to this finding, two supernumerary cusps were present on the tooth. One was in the center on the oblique ridge, and another was on the side of the mesiolingual cusp [Figure 1]. Intraoral periapical radiograph showed the extension of the pulp into the two supernumerary cusps [Figure 2]. According to the presentation, we categorized the one on the oblique ridge into Schulge's Type III and another one on the lingual cusp into Type II of DE [Figure 3].
Figure 1: Carious 16 with double Dens evaginatus.

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Figure 2: Intraoral periapical radiograph of the same tooth.

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Figure 3: Sixteen after restoration.

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The tooth was restored with light-cured restorative material using sandwich technique as the caries was deep [Figure 3]. The patient was on follow-up.


  Discussion Top


The etiology of extra cusp formation or abnormal shape is unknown. However, previously, it was thought to arise genetically during morphodifferentiation stage of tooth development, as a result of outfolding of the enamel organ or hyperactivity of the dental lamina.[5] However, now, it is believed that the PAX and MSX genes are responsible for the abnormal shape of the teeth.[6]

In the case presented here, there are two DE on 16. One DE can be categorized into Type II DE as this supernumerary cusp is on the lingual crown side and the original lingual cusp is clearly seen next to the supernumerary cusp. The second DE can be categorized into Type III as it is situated on the occlusal surface [Figure 3]. Radiographic examination revealed pulp horn extension was in both the DE [Figure 2]. The presence of pulp within the cusp-like tubercle has great clinical significance and distinguishes the anomaly from supplemental cusps, such as the cusp of Carabelli,[7] which contain no pulp. DE arises most frequently from the occlusal surface of involved posterior teeth whereas talon cusp originated as a descriptive term for DE when observed on the lingual surface of anterior teeth because of a resemblance to an Eagle's Talon.[3]

DE primarily involves the premolars. It usually occurs in the mandibular premolars. The rate of occurrence in the mandibular molars is 3 or 4 times higher than that in the maxillary molars. Moreover, the occurrence is 3 or 4 times higher in the maxillomandibular second premolars than first molars.[8] These reports suggest that the occurrence of DE in maxillary first molar is very rare. Moreover, there is no reference of double DE on permanent maxillary first molar till date.

The presence of these additional extensions of tooth structure may pose various dental problems to clinicians such as caries in the pits or deep developmental grooves between the accessory cusp and the tooth, sensitivity or devitalization of tooth due to fracture or attrition of the protruded portion of the cusp that has pulpal extension, and premature tooth contact that leads to occlusal interference and habitual posturing of the jaw.

In the present case, there was deep caries with respect to 16 which was restored with light-cured restorative material using sandwich technique, and the patient was on follow-up.


  Conclusion Top


DE is a dental anomaly that commonly involves premolars. We reported a case of double DE on a permanent maxillary molar which is rare. Till date, there is no such reported case. Deep caries of this tooth was treated and the tooth was restored.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ooshima T, Ishida R, Mishima K, Sobue S. The prevalence of developmental anomalies of teeth and their association with tooth size in the primary and permanent dentitions of 1650 Japanese children. Int J Paediatr Dent 1996;6:87-94.  Back to cited text no. 1
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2.
Neville B, Damm D, Allen C, Bouquot J. Oral and Maxillofacial Pathology. 2nd ed. Philadelphia: WB Saunders; 2002. p. 77-9.  Back to cited text no. 2
    
3.
Kocsis G, Marcsik A, Kokai E, Kocsis K. Supernumerary occlusal cusps on permanent human teeth. Acta Biol Szeged 2002;46:71-82.  Back to cited text no. 3
    
4.
Levitan ME, Himel VT. Dens evaginatus: Literature review, pathophysiology, and comprehensive treatment regimen. J Endod 2006;32:1-9.  Back to cited text no. 4
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5.
Thakur S, Gupta R, Thakur NS, Gupta M. Facial talon cusp on permanent maxillary canine: A rare dental anomaly. Eur J Gen Dent 2013;2:324-7.  Back to cited text no. 5
  [Full text]  
6.
Sedano HO, Ocampo-Acosta F, Naranjo-Corona RI, Torres-Arellano ME. Multiple dens invaginatus, mulberry molar and conical teeth. Case report and genetic considerations. Med Oral Patol Oral Cir Bucal 2009;14:E69-72.  Back to cited text no. 6
[PUBMED]    
7.
Ash M. Wheeler's Dental Anatomy, Physiology and Occlusion. 8th ed. Philadelphia: WB Saunders; 2003. p. 241-2.  Back to cited text no. 7
    
8.
Morinaga K, Aida N, Asai T, Tezen C, Ide Y, Nakagawa K. Dens evaginatus on occlusal surface of maxillary second molar: A case report. Bull Tokyo Dent Coll 2010;51:165-8.  Back to cited text no. 8
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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